Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.
Login or Create an Account
For background reference: my sleep study (done back in 2020) showed an AHI of 15, nearly all hypopneas.
I was having some success with the Resmed P10 Nasal pillows usually getting my AHI down under 2. This was with pressure set between 9 and 13 with an EPR of 3. I think this was recommended here as a good setting for mostly hypopneas.
However like many I had trouble keeping my mouth shut. I tried a chin strap and didn't really like it, it was a bit warm and the hassle of putting it on every night was annoying. In the end I mostly just taped my mouth shut. I got pretty good at doing this right before I went to sleep with a bit of pre-cut tape stuck to the bedside table, but it was still annoying, and peeling it off the next day wasn't any fun, and sometimes it got all wet and fell off, and it made coughing impossible which was also no fun. In the end I got fed up enough to just stop using the machine.
So recently I decided to give things another go with a FFM. I went for the Resmed Airtouch F20, I first tried the silicone interface (medium size) but it pinched my nose quite painfully. Then I tried the memory foam ones and these were much better, I'm actually comfortable using these and it's more convenient to pop the mask on (quickly due to the magnetic clips) and and connect the hose that I have hanging over my headboard, only takes a second and no undignified taping of the mouth shut anymore! So in this respect, I'm happy
However my AHI seemed to get much worse. I was getting 10 AHI some nights. This was with same range of 9-13 and EPR at 3. I gave it a few days and it improved slightly not not enough really. So I had a rethink and browsed this forum and firstly tried a higher range (between 11 and 15), and this didn't really seem to help plus it made the mask leak more easily. I then found a thread where someone had had success with treating majority hypopneas using a lower pressure than generally advised, and just fixing it to 8 pressure as min and max (so essentially CPAP mode) . I'm currently trying this and it's very comfortable and the mask doesn't leak, but in the morning my AHI still isn't great. 2 nights ago was 5.8 and last night was 8.85.
So I have my graphs from Oscar and was hoping someone could take a look and advise what I could try. These are the last two nights attached.
It doesn't seem like 8cmH20 is high enough to keep the obstructive events (light blue) at bay so I'd recommend increasing your pressure by 1cmH20 every night until you rarely see them.
You are showing some positional apnea. Positional apnea can NOT be controlled by pressure changes. You have to find out what position you are getting into and cutting off your own airway. Have you changed your sleep position? Sleeping on your back? Using more (or new) pillows? These things can cause positional apnea by chin dropping to your sternum and cutting your airway. Think of it of a kinked hose – nothing can get through – you have to unkink the hose…
IF you can’t make a simple change like changing to a flatter pillow helps then you will need a collar. I have a link to collars in my signature at the bottom of the page. It shows people who are not wearing a collar and the SAME person wearing a collar. There is a huge difference between the two.
As another post said the group or clustered Oa and H events show Positional apnea.
08-23-2023, 10:33 AM (This post was last modified: 08-23-2023, 10:36 AM by buffeh.)
RE: Switched from Nasal to FFM, higher AHI, help!
Thank you for the replies everyone. I do mostly sleep on my back nowadays.
I started lifting weights in 2018 and it made my shoulders broad to the extent that it is too uncomfortable to sleep on my side. Maybe this is where my problems started.
My sleep study from 2020 showed that nearly all my hypopneas were when I was supine (on my back). The recommendation from the consultant who commented on my sleep study was either a positional sleep aid OR a CPAP machine.
I find it more comfortable to sleep with a CPAP mask on, while lying on my back, than I do to sleep on my side with no CPAP. I made the assumption that using a CPAP would allow me to sleep in whatever position I wanted without suffering from hypopneas, this assumption was backed up by the sleep study consultant suggesting CPAP therapy as a solution, despite the events only happening on my back.
At one point I tried using a positional sleeping aid (a thing that vibrated and woke me up when I rolled onto my back) while not using a CPAP, but it is just too uncomfortable to lie on my side.
Now apparently it is being suggested here that no CPAP setting will help with my positional apnea. I am going to feel quite silly if my multi year attempts to solve my problems using a CPAP have been completely pointless, but better to know late than never I suppose.
I really can't sleep on my side unless someone can suggest a magical way of doing so. I do sleep on two pillows so my neck is quite raised up, but I think I've tried using one and don't remember feeling much different. I can try again, or try a buckwheat pillow.
Or of course I can try a cervial collar, would this allow me to sleep on my back without issue? Presumably I should be using this with just one pillow or a buckwheat pillow or something?
Please help, this has been causing me issues for years
Oh also if I do try things like a cervical collar or different pillows or whatever, can I also use the CPAP as a test to see if it's working and I'm not having events? (i.e use the CPAP as a sleep study machine basically, then stop using it once I know I've fixed my sleeping position)
Bump, I tried sleeping with only one quite flat pillow and I thought my neck was pretty aligned and chin not tucked but maybe in the night I tipped my head to the side in such a way that it was - either way I still got an 8 AHI reported in the morning.
I should reiterate that I had a low AHI while using a nasal mask, so presumably my positional apeas were being treated? I would assume the Resmed Airsense 10 would capture positional apneas. And now I've changed nothing really except to a FFM, I'm getting a higher AHI reported from the Resmed (usually 7-10 AHI). So I am a bit confused by the responses that say no pressure changes can treat a positional apnea, as I wasn't really getting any when using a nasal mask (unless something about the nasal mask makes the Resmed miss them)
09-05-2023, 06:20 AM (This post was last modified: 09-05-2023, 06:21 AM by buffeh.)
RE: Switched from Nasal to FFM, higher AHI, help!
I'm a bit sad that nobody has replied to my thread but I imagine I'll get over it.
So I tried out a cervical collar as was recommended. And my AHI immediately dropped to 0.5 (with 4 hours sleep) and 1.5 (with 6 hours sleep) respectively over 2 nights. So unsurprisingly you guys were onto something as you usually are!
So as mentioned above I'm now confused, do I even need a CPAP? Have I been wasting my time with one this whole time? Is there any way to see if I actually need one, beyond getting yet another home sleep study and taking it while wearing a cervical collar?
And to add another spanner in the works, I sought out an in lab sleep study taken while using CPAP (which uses a camera and ECG) as I spent the last few years not feeling well rested despite using CPAP. And the recent outcome of that is that I have PLMS, 25 arousals an hour, established with pulse transit time. My wife said in recent years I've been "twitchy" in bed, but only with small movements so they didn't wake her up, so she obviously didn't realize the extent of it. So no wonder I'm still tired. They have started me on gabapentin for that, it's early days so I doubt it's working yet. So that's something I will have to think about for the rest of my life, which is fun.
However it would be less upsetting if I could establish whether I need to use a CPAP or not given the results with the cervial collar, so again, please, please please any thoughts appreciated.
09-05-2023, 06:44 AM (This post was last modified: 09-05-2023, 06:45 AM by buffeh.)
RE: Switched from Nasal to FFM, higher AHI, help!
Hm I do wonder if the lower AHI is the cervical collar holding my mouth closed rather than keeping my head back. Like I said before, I was getting low AHI using a nasal mask with my mouth taped shut, but with no collar to stop my chin from tucking. With this setup, my AHI was low and my APAP didn't set the pressure any higher than 9.5. My AHI shot up when I changed nothing except to a FFM where I'm sure my mouth is opening when I sleep. The whole point of switching to a FFM was so I could open my mouth when I slept with reckless abandon and wouldn't have to tape it shut anymore! With this change, I was getting a higher AHI and the machine was maxing the pressure out at 13.
If I tape my mouth shut with a FFM but don't wear the collar, and my AHI returns to a low number, would anyone care to comment on what that might mean? Surely treatment should be just as effective whether air is going into the nose, or mouth, or both? I don't really know what's going on.
but I imagine I'll get over it.